The Gynae Geek: Your no-nonsense guide to ‘down there’ healthcare. Dr Mitra Anita

to be worrying, remember that it can be normal for teenagers to have irregular periods and may take about five years from when they start to settle down into a more regular cycle.¹⁸ So it’s not always wrong to leave things alone to see if they sort themselves out, but it very much depends on what else is going on and what other symptoms she may be having, so do discuss this with your GP if you are worried.

       Are there any health risks associated with hypothalamic amenorrhoea?

      First and foremost, the thing that most women are worried about is fertility. If you’re not ovulating, you can’t get pregnant. So if you want to have a baby in the near future, you need to speak to your doctor as soon as possible.

      One of the biggest risks with HA, however – and many women are not aware of this – is the risk of brittle bones and heart disease that can arise due to a lack of oestrogen, which I would suggest is just as important as your fertility. I’m really passionate about ensuring this message filters through. We often tend to focus on short-term, tangible outcomes, forgetting the things we can’t see. ‘I’d rather look shredded now and deal with my bones when I get older,’ one patient told me. But that’s the problem. You can’t deal with your bones later. Peak bone strength in females occurs around the age of thirty, and if you’re not building it in those crucial teens and twenties you can’t catch up later. Build it now, for benefits down the line.

       Does PCOS increase the risk of ovarian cancer?

      This is the thing that everyone worries about. PCOS itself does not increase your risk of getting ovarian cancer,¹⁹ but obesity and diabetes, both of which are associated with PCOS, may do so. It’s important, therefore, to try and implement some of the lifestyle changes discussed here.

      PCOS does increase the risk of endometrial cancer (cancer of the lining of the uterus),²⁰ the greatest risk being to women who are less physically active, regardless of obesity or diabetes.²¹ So anything you can do to increase the amount of movement you do may reduce your risk, irrespective of whether you actually lose weight,²² which is another reason why I prefer to steer away from concentrating on weight loss as a specific goal.

       I had a scan that shows I have polycystic ovaries – what are the implications of this?

      ‘Polycystic’ means having lots of cysts. With regards to your ovaries, this means you have loads of follicles that are trying to mature and break free. Up to 25 per cent of women have ovaries with a polycystic appearance,²³ and it’s particularly common in younger girls who have started their periods in the last few years because their ovaries are literally bursting with eggs wanting to get out. However, it doesn’t automatically mean you have polycystic ovarian syndrome (PCOS), if you don’t have any of the other classic symptoms (see here).

THE GYNAE GEEK’S KNOWLEDGE BOMBS

      Irregular or absent periods cause so much anxiety, so I hope this chapter will have put your mind at ease, giving you a few areas of your life to re-evaluate if this is a particular problem for you. The most important takeaways here are:

       Lazy ovaries do not exist. If you stop having periods it’s because your ovaries aren’t receiving the right messages from the brain, or other hormones are influencing their activity.

       Premature menopause is very rare and unlikely to be the cause of irregular or absent periods, but it is very easy to check for with a simple blood test.

       Your body is very clever and is able to stop your periods if you are stressed, overexercising or not eating well, as a survival tactic to conserve energy for things that are more important than making hormones.

       The contraceptive Pill will not cure PCOS. It will merely cause you to have a period every month, but when you stop the Pill, if you haven’t made any lifestyle changes, your body will resume the same cycle as before you started it.

       Lifestyle changes including diet, exercise and stress management can have a massive positive impact on PCOS. They also reduce your risk of complications such as diabetes, heart disease and female cancers.

CHAPTER 5

       Heavy periods and other period-related frustrations

       ‘I hate leaving the house on the first few days of my period because I’m so scared of leaking through my clothes.’

      If you skipped the introduction to this book you need to go right back there and read the story here, which illustrates how horrendous periods can be and the dramatic impact they can have on women’s lives.

      I’m sure you know someone who has terrible periods, but they may not talk to you about it, and, as a result, many of us don’t know what other people’s periods are like, or even whether our own are ‘normal’. As a result, many women feel ashamed, and so they suffer in silence, not leaving the house for the first few days due to pain or needing to change their pads constantly, or through fear of leaking.

      There are a lot of things that can be done to improve the situation, but your doctor has to actually know that you are having problems, so don’t be afraid to go and talk to them about it. As doctors, we’re not fazed by things you wouldn’t dare tell anyone else, nor do we expect you to use any complex medical lingo. I can usually tell when a patient is shy and embarrassed, and try and use all the awkward words in my first few questions, just to prove to them that it really is safe to say whatever they want to.

      My advice is to keep it simple by giving a basic explanation of what’s going on in language that you feel comfortable using and your doctor will use their expertise to ask you for more info.

       Heavy periods

      One in five women will experience heavy periods, also known as menorrhagia – literally, raging periods. Let’s look at what this means.

       How heavy is heavy?

      The textbooks state that anything over 80ml blood loss is classified as heavy. But what does that even mean? No one sits over a jug and measures it, and it’s incredibly difficult to quantify the amount on a sanitary pad or tampon. A more helpful way of classifying a heavy period would be any of the following:

       Changing pads/tampons at least every hour for several hours in a row

       Needing to use a pad and a tampon at the same time